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Sunday, 12 May 2013

CLIPPERS?

Regular readers will know that the individual CLIPPERS case studies coming out now seem to be about CLIPPERS in conjunction with other conditions. I think pure individual cases of CLIPPERS are not adding much to previous research, but studies with large numbers of subjects are much harder to organise, especially with the still relatively small number of cases.

So this new paper is about a case of Lymphoma following CLIPPERS. This seems to be better argued (at least in my definitely inexpert opinion) than this previous one relating CLIPPERS to previous influenza. This new connection is slightly worrying, as the authors discuss possible mechanisms (that I don't pretend to understand) whereby this case of CLIPPERS was an early indicator of something worse.

As ever, it is impossible to draw strong conclusions from a study of one patient and, given that this link has not been previously reported, it is certainly not common in the studies which have been seen to date. When I was being diagnosed, I was told some form of Lymphoma was a possible alternative diagnosis and crucially, that it would also respond to steroid treatment but only in the short term. In this paper, the steroid treatment seemed to become less effective quite quickly and MRI subsequently showed a very un-CLIPPERS like lesion, even though the early appearance was CLIPPERS-like. I held my breath for about the first 3 months I was on steroids but when my improvement was sustained, it became less likely to be Lymphoma. So is this case CLIPPERS becoming Lymphoma or early Lymphoma mimicking CLIPPERS? I tend to think it's the latter as diffuse Lymphoma is reportedly very rare and very hard to diagnose. But I am not a doctor so what do I know!?